Prostate Cancer; When Watchful Waiting is the Answer

Patients are used to asking the question, “When do we starting treating it and what type of treatment will we use?”. But with prostate cancer in many cases the answer could be “We’re not going to treat it.” The “wait and see” approach may well be the right option for your prostate cancer.

Watchful Waiting/Active Surveillance

Also called “active surveillance” the term “watchful waiting” describes one way to “treat” prostate cancer. It is used to describe cases where the prostate cancer patient has opted to refuse surgery, radiation, hormone therapy, and any other medication to treat the prostate cancer. Instead of treatment doctors will rely on prostate-specific antigen (PSA) tests and digital rectal exams (DRE) to monitor disease progression. If and when one of these tests show that the cancer is progressing, at that time other more active treatment options may be considered.

Certain types of prostate cancer can be very slow to progress; some men who have it will never experience any symptoms or problems. Occasionally the disease can actually be less damaging than the treatment. Prostate cancer can be monitored regularly with frequent testing — about every six months — and without surgery or radiation. According to a large, long-term study of nearly 800 men with prostate cancer, the risk of dying from a “low-risk” tumor is similar whether you choose observation or treatment.

Are You a Good Candidate for Watchful Waiting?

Not all patients are good candidates for watchful waiting. Younger men or men who have aggressive prostate cancer are often recommended to take a more proactive approach to treatment, but older men who are concerned about side effects — commonly, impotence and incontinence —may want to consider watchful waiting.

The following are other factors that can indicate whether watchful waiting is a viable treatment method for a prostate cancer patient:

• Early stage diagnosis. The earlier the stage at diagnosis, the more time a prostate cancer patient may have in determining what treatment plan is best.
• Short life expectancy. If a man has a life expectancy of less than five years for other medical reasons he may opt for watchful waiting.
• Having another serious health condition. If a patient is struggling with another disease or health condition, they may not want to proceed with surgery or radiation for prostate cancer at the same time.
• Gleason score. When the cancer is not aggressive and is slow to progress, a man may have a low Gleason score. This patient may consider watchful waiting as an option.

Erectile Dysfunction and Prostate Cancer

Erectile Dysfunction and Prostate Cancer

Sexual function is an important topic but one that men might not put at the top of their priority list after receiving a diagnosis of prostate cancer. Many men fear impotence as a side effect of the treatment/disease.

Prostate Cancer Treatment; Why Erectile Dysfunction May Occur As A Result

The side effect of impotence may be a result of the treatment options for prostate cancer which may include surgery or radiation. Both of these two treatment options can affect the nerves surrounding the prostate that enable a man to have an erection.

One of the primary reasons for impotence as a side effect is that the prostate gland surrounds the base of the bladder and the base of the penis, and consequently nerves that are related to both sexual function and urinary function can be damaged either by the prostate cancer cells themselves or by the treatment. An impact on these nerves is fairly common; it all depends on where the cancer is located.

In a radical prostatectomy, the nerves may be removed or they may become damaged. In some occasions even when there is no nerve damage, impotence may still occur in men who have had surgery to treat prostate cancer. In these cases it could be that the veins and blood vessels in and around the penis have sustained damage during surgery, which can affect the ability to have an erection.
When undergoing radiation therapy, prostate cancer patients may experience damage to the blood vessels to the penis, and therefore issues with impotency may occur over time.

Which Men Are Affected?

Your age, sexual health and the type of treatment that you received can all determine wow likely you are to become impotent following prostate cancer treatment.
Younger me (40 to 49) and those men who have had healthy erections before prostate cancer treatment are more likely to be able to achieve erections after treatment. Men with tumors that have grown beyond the prostate are more likely to experience erectile dysfunction.

The risk of impotence is much lower if the patient has nerve-sparing surgery. However, if the nerves are damaged during this type of surgery, many men may still experience some temporary erectile dysfunction for 2 to 18 months afterward.

What You Can Do About Erectile Dysfunction

A strong relationship with your partner in addition to patience and the passing of time can help improve your sexual health after prostate cancer treatments. Most men feel anxious and worried about this side effect, but doctors should be counseling patients and advising them that the nerves around the prostate require time to heal.

Studies have shown that couples counseling can be of great help to men after prostate cancer treatment. There are also several medications and devices that may help:

• Prescription medications. A number of prescription medications that can be taken orally, including such brand names as Levitra, Cialis and Viagra. These drugs help to increase blood flow to the penis. They work best in prostate cancer patients who still have healthy nerve bundles on each side of the prostate.

• Medication injections. To help increase blood flow and stimulate an erection there are medications that can be injected into the side of the penis. Once a doctor shows you how to administer them the injections can be given at home by a partner.

• Surgical implants. Some men choose a permanent penile implant that can be surgically inserted in the penis to facilitate erections.

• External devices. A pump attached to a tube that covers the penis and creates a vacuum is an option. This stimulates an erection by increasing blood flow to the penis. For a short period of time s ring may also be placed on the penis to maintain an erection.

It is important to note that not every man who gets treated for prostate cancer will experience erectile dysfunction. Men should talk with their doctor about treatment options and medical devices and drugs that can be used post-surgery.
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African-American Men; Prostate Cancer Risk

Men of all ages should be concerned about and aware of the signs of prostate cancer. It’s recommended that men talk to their doctors about when they should be screened based on their family history and other risk factors. Early screening is especially important if a man has one or more risk factors and is at an increased risk of developing prostate cancer.

Statistically it is a fact that men of African-American descent are at a higher risk of developing prostate cancer than white men. 19 percent of black men, almost one in five — will be diagnosed with prostate cancer. Five percent of that group will eventually die from the disease. Prostate cancer is the fourth most common reason for death in African-American men.

The risk for prostate cancer in African-American Men is greater, but how much greater?

No one is certain of the reasons why black men are at an increased risk of developing and dying from prostate cancer. In part this group is more likely to die from prostate cancer in part because of delayed diagnosis and also because of limits in access to treatment. One recent study suggests that there may be a genetic link.

If there is a family history of prostate cancer for an African-American man, their risk increases dramatically. Those with an immediate family member who had prostate cancer have a one in three chance of developing the disease. This risk rate increases to 83 percent if two immediate family members have had the disease.

It’s so important to have early prostate cancer screening, and here is why:

By the time noticeable symptoms of prostate cancer appear, the cancer is likely in an advanced state so early prostate cancer screening is of utmost importance. The changes of recover increase the earlier the prostate cancer is caught.

When caught early, prostate cancer is highly treatable. Nearly 100 percent of men who are diagnosed with prostate cancer in its earliest stage will be alive five years later.

African American men should have prostate cancer screening at young age.

For African American men, routine prostate cancer screening should start at a young age; the American Cancer Society recommends that these men discuss testing with their doctor at age 45, or at age 40 if they have several close relatives who have had prostate cancer before age 65.

There are some different types of screening tests and those can include a prostate-specific antigen (PSA) blood test and/or a digital rectal exam (DRE). A family doctor can usually perform both tests.

The signs and symptoms of prostate cancer are important for all men to know. These symptoms can include urinating in the middle of the night, urinating more frequently than normal, and feeling like the bladder doesn’t completely empty. Also blood in the urine may be a sign of prostate cancer.

If men experience these symptoms it is important for them to talk to their doctor about diagnostic testing for prostate cancer.

Weighing Your Prostate Cancer Treatment Options

Men diagnosed with prostate cancer now have many treatment options available to them, including radiation, surgery, and drugs that stop the growth of the prostate cancer.

With so many choices, all of which have their own benefits and risks, choosing the best prostate cancer treatment can be difficult. The most appropriate therapy will depend upon the size and aggressiveness of the cancer, as well as whether it has spread to other parts of the body. In some cases, multiple treatments are used.

Watch and Wait: Active Surveillance of Prostate Cancer

Improved screening and detection of prostate cancer means that many cancers are found long before they are likely to pose a serious threat.

When theprostate tumor is very small or slow-growing (early stage), many men opt to “watch and wait,” an approach known as active surveillance.

This doesn’t mean do nothing. Your prostate cancer will be monitored regularly for changes in its size or growthusing:

exams
blood tests
imaging (such as MRI)
follow-up biopsies.

Radiation Treatment for Prostate Cancer

Radiation can be used to kill prostate cancer cells. Improved methods have allowed doctors to use higher doses of radiation, but with fewer side effects. The two main types are:

External beam radiation therapy (EBRT).X-rays are aimed at the prostate cancer from outside the body.
Radioactive material implants(Brachytherapy). Thisinvolves placing radioactive material (or “seeds”) inside the prostate gland.

Prostate Surgery

During prostate surgery, the prostate gland is removed (radical prostatectomy), along with any nearby lymph nodes (part of the immune system) that have become cancerous.

While any surgery has a risk of complications, minimally invasive techniques, such as robotic prostatectomy using the da Vinci® Surgical System, combines the latest robotic and surgical techniques. Prostatectomy performed using the robot has many benefits, such as:

less pain and blood loss
fewer complications
shorter stay in the hospital
faster return to your normal activities.

Success of this procedure depends on both the skill and experience of the surgeon, as well as the technique used.

Hormone Therapy for Prostate Cancer

Hormone therapy blocks or reducesthemale hormones, such as testosterone, that fuel the growth of prostate cancer. Side effects include decreased sex drive and loss of muscle mass. This treatment can involve:

Androgen deprivation therapy (ADT), which blocks the production of testosterone using either medicines or removal of the testicles (the place where testosterone is made).
Anti-androgens, medicines that keep the prostate cancer cells from using testosterone.

Treatment Options for Advanced Prostate Cancer

If the prostate cancer moves beyond the prostate gland (metastasis)—such as into the lymph nodes or other organs—doctors may use multiple types of therapies in order to treat this aggressive form of cancer.

In addition to hormone therapy, another treatment option is chemotherapy, which uses special drugs to slow or stop the growth of prostate cancer cells. These drugs are usually given in cycles, such as every 21 or 28 days.

The main side effects of chemotherapy are:

nausea and vomiting
temporary hair loss
drop in white blood cells which increases the risk of infection.

Men’s Prostate Health Event – Dec. 12th in River Falls

Know Your Stats Conference - Dr. Gaertner, Dr. Knoedler

Dr. Gaertner and Dr. Knoedler have been invited to speak at the Dec. 12th Men’s Prostate Health Event in River Falls, WI. The event will be held at River Falls Area Hospital Conference Rooms. At the conference, Dr. Gaertner and Dr. Knoedler will present on the latest advancements in prostate screenings and other risk factors, options and treatments. The event will contain patient stories, presentations and videos.

One lucky attendee will with a $100 Cabellas gift card!

To register call 715-307-6060. Space is limited.

da Vinci Prostatectomy Chosen Most for Prostate Cancer Treatment

More U.S. men choose da Vinci Surgery than any other treatment for prostate cancer, and more and more men worldwide facing prostate cancer are choosing da Vinci Surgery.

Thanks to breakthrough surgical technology, Dr. Gaertner and Dr. Knoedler can offer a minimally invasive treatment for prostate cancer – da Vinci Prostatectomy. Studies show that, compared to open surgery, experienced da Vinci surgeons achieve better cancer control – lower positive margin rates. Positive margin rates are a measure of cancer cells left behind – lower is better.

Recent studies show more patients have full return of urinary continence within 6 months as compared to patients having open surgery

Shorter hospital stay
Lower risk of complications
Lower risk of wound infection
Fewer days with catheter
Less pain
Faster recovery and return to normal activities

To learn more, check out our section on [da Vinci Prostatectomy].

3rd Annual Prostate Cancer Awareness Golf Tournament

On August 13th Metro Urology hosted the 3rd Annual Prostate Cancer Awareness Golf Tournament at Kilkarney Hills in

River Falls, WI. The mission of the Metro Urology Foundation is to provide educational opportunities where people living

with urologic conditions, and their families and friends, can join with others to increase their knowledge and understanding of the urologic conditions they live with daily.

To learn more about the event [Click Here].

Metro Urology A Sponsor of Dash for Dads Sept 22

The DASH FOR DAD is part of a national initiative designed to raise funds for prostate cancer research and community awareness. The race is part of the Great Prostate Cancer Challenge®, America’s Premier Men’s Health Event Series, taking place in 2012.
This year Metro Urology will be a proud sponsor of the event held in Minneapolis, MN.

To register, donate, or to learn more [Click Here].

John Soucheray completed a Triathlon 8 weeks after surgery

Dr. John Soucheray Dr. John Souchery was diagnosed with prostate cancer. Himself an experienced urologist, he was well aware of the treatment options and outcomes for the treatment of prostate cancer. As a husband, and a grandfather and an active career as well as an active lifestyle, Souchery could not afford a long treatment process.

The choice was simple: surgical removal. Minimally invasive robotic surgery was the clear method of choice.

Through the expertise of Drs. Knoedler and Gaertner, the cancerous prostate was removed using the da Vinci Surgical System allowing a much faster recovery. Only 8 weeks later, Souchery completed an olympic distance triathlon, recovered from surgery.